As Regional Abortion Clinics Close, Is It Time To Make The Abortion Pill More Accessible?

In the coming weeks, Marie Stopes — Australia’s only national abortion provider — will close four clinics across regional NSW and Queensland.

“It’s been one of the hardest decisions we’ve had to make,” Managing Director Jamal Hakim told Junkee. According to Marie Stopes, the closures come after exhausting all possible options to keep the regional clinics in operation.

“Women who are in more complex situations, where there is domestic violence, where there may have been sexual assault … are the ones who will be most impacted,” said Hakim.

Which Abortion Clinics Are Closing?

In NSW, the Newcastle clinic will close. In Queensland, the Gold Coast, Townsville, and Rockhampton clinics will all permanently shut their doors, making it trickier for people living in regional and rural areas to access vital healthcare.

This comes as yet another development in Australia’s convoluted history of abortion access, that has been dubbed a “postcode lottery”.

Last year, as state borders closed and aircraft grounded, Marie Stopes — with financial support from the Queensland Government — flew a clinician and staff in a chartered plane from Brisbane to Rockhampton and Townsville every week through the lockdown to keep clinics open and accessible.

“Abortion is decriminalised across Australia now and it needs to be embedded into the public health system as part of healthcare.”

Hakim told Junkee that stigma around abortion in the regions made it challenging to staff the clinics and find supplementary financial ways to keep them running.

“What we really need to see is that, abortion is decriminalised across Australia now and it needs to be embedded into the public health system as part of healthcare,” said Children By Choice CEO Daile Kelleher.

Excluding hospitals — which don’t automatically provide surgical abortions, and where medical professionals can conscientiously object to providing the service — Queenslanders have had access to eight private surgical abortion providers. The loss of three private clinics reduces surgical abortion options in the state by more than a third.

Kelleher told Junkee that of the 1400 Queensland people Children by Choice speaks with each year, the average distance they travel to access an abortion is 100km. For someone seeking an abortion in Longreach, for example, it would take more than 10 hours in a car to reach the nearest private clinic in Cairns.

“Outside of any hospitals that are providing surgical terminations, everyone within regions would have to travel to Brisbane to access a private clinic,” said Kelleher.

What Do The Closures Mean For People Seeing An Abortion?

As there is no standardised national abortion access in Australia, data on how many people terminate pregnancies can be hard to find. However, it’s estimated that about half of all pregnancies are unplanned — and that half of those unplanned pregnancies are terminated.

Getting a termination can mean aligning an available appointment with state law, along with time off work, travel, childcare, and more.

There are currently two types of abortion available: medical abortions, available for up to nine weeks, requiring two pills; and surgical abortions, available up to 22 to 24 weeks depending on your state or territory.

Getting a termination can mean aligning an available appointment with state law, along with time off work, travel, childcare, and more. These requirements can be compounded further when you have a longer distance to travel, adding excess time and money. And this is not to mention further concerns around domestic violence and reproductive coercion.

Family Planning NSW’s 2020 report on access to abortion states there’s a ‘clear link’ between domestic violence and unintended pregnancy.

“Given the controlling nature of domestic violence, including the abuser’s control of reproductive health and finances, women who experience forms of violence can take longer to access abortion and significantly increasing costs,” the report reads.

With that, any reduction of access to abortion services is a harmful one.

In response to Marie Stopes’ Newcastle clinic closing, a spokesperson from Family Planning NSW told Junkee the organisation wants to see reproductive and sexual healthcare improve “particularly for people already facing challenges because of issues like location, culturally and linguistically diverse status, financial circumstances or because they are young”.

“Surgical abortion in the Hunter is offered through private providers, and there are established referral pathways developed through the public health network and local health district. It is also possible for patients to be referred to Family Planning NSW’s Sydney clinic,” said the spokesperson.

The NSW Family Planning report estimated that in the Hunter New England region — where Newcastle is located — 1766 women would have accessed a surgical abortion and 323 a medical abortion in 2020.

So, How Can People In Regional Areas Access Abortion?

According to Marie Stopes, while the Queensland Government is working with them to fill the gaps the clinics will leave behind, there has been no sign of collaboration from the NSW Government.

However, a spokesperson from NSW Health told Junkee the body is “fully committed” to supporting people seeking an abortion.

The NSW government has established a Pregnancy Choices hotline (1800 008 463) which provides information on pregnancy choices, including accessing termination of pregnancy services. But Marie Stopes feels even more support is needed — and NSW Shadow Minister for Women Jodie Harrison agrees.

“The hotline could certainly provide people with verbal assistance,” Harrison told Junkee. “But it doesn’t provide them with any actual solutions … Losing a service like Marie Stopes in a regional area means that there will be additional pressure on other services. And not all hospitals provide surgical abortions — most provide referrals to services.”

NSW Health also says it will be providing $1.2 million to Family Planning NSW to “pilot a new service model to improve access to affordable termination of pregnancy and contraception services in regional and rural NSW.”

It says the delivery is expected to start in the second half of 2021. But what happens in the meantime?

Is It Time To Extend Medical Abortions?

Surgical abortions have been steadily declining across Australia over the last two decades, according to Family Planning NSW’s Induced Abortion Australia: 2000-2020 report, which was released this week.

“Increases in medical abortion have, at least partly, compensated for the reduction in surgical procedures,” said Family Planning NSW Medical Director, Dr Deborah Bateson.

“The vast majority of abortions continue to be carried out before 14 weeks,” she told Junkee.

Medical abortions — the pill option — are available via Telehealth and participating doctors, to end a pregnancy of up to nine weeks. Marie Stopes found demand via Telehealth increased 150 percent across the country during the pandemic last year.

However, medical abortions don’t suit every person or circumstance. “If you’re over seven weeks gestation, you can’t do a Telehealth abortion, because they need to make sure that the medication gets sent out to you before that nine-week period,” said Kelleher.

“In line with what’s happening internationally, there’s certainly no reason we cant extend the gestational limit for medication abortion.”

This means people in Australia must be aware of their pregnancy, have their decision made, and secured a Telehealth appointment at just seven weeks into their pregnancy to allow time for their medication to arrive.

In the UK, medical abortions are available for up to 10 weeks through a pregnancy. In the US, it’s up to 11 weeks, depending where you live.

Kelleher believe the timeline for medical abortions in Australia should be extended. “In line with what’s happening internationally, there’s certainly no reason we cant extend the gestational limit for medication abortion,” she said.

Marie Stopes believes the process for extending access to medical abortions would require significant investment — potentially hundreds of thousands of dollars — and further approval from the TGA, which could take up to 18 months.

“That’s something that we’ve discussed internally for a little while,” said Hakim. “And I think something that could be a real benefit.”

Looking to the future, Marie Stopes continues to focus on ways to make abortion more easily accessible, including nurse-led care.

“We are completely committed to making sure that every single person has access to their bodily autonomy ultimately and wherever they are,” said Hakim.

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Edwina Storie is a multi-platform journalist with a focus on sex and gender issues.